Efficacy of erector spinae plane block in pain management for patients with herpes zoster: a systematic review and meta-analysis

Objectives

Systematic review and meta-analysis to evaluate the efficacy of the Erector Spinae Plane Block (ESPB) in managing pain related to Herpes Zoster.

Methods

We systematically searched PubMed, Embase, Cochrane Library, and CNKI for randomized trials comparing ESPB plus standard clinical treatment with clinical treatment alone. The population included patients with acute infection and those with Postherpetic Neuralgia (PHN). The primary outcome was pain intensity, and secondary outcomes included analgesic consumption. Mean Difference (MD) was used for continuous outcomes, and Risk Ratio (RR) for binary outcomes.

Results

Seven trials with 362 patients were included. ESPB significantly reduced pain up to eight weeks (MD = -1.21; 95% CI -2.17 to -0.24; I² = 89%). In the subgroup analysis of patients in the acute stage, the benefit seemed to extend with pain reduction lasting up to 12-weeks (MD = -1.49; 95% CI -2.61 to -0.37; I² = 0%), and a reduction in the incidence of PHN (RR = 0.49; 95% CI 0.28 to 0.85; I²: 0%). In the PHN subgroup, pain reduction was notable only at four weeks (MD = -1.08; 95% CI -1.81 to -0.35; I² = 86%). ESPB also reduced acetaminophen (MD = -0.6 g.day^-1; 95% CI -1.05 to -0.14; I² = 49%) and pregabalin consumption (-68.58 mg.day^-1; 95% CI -127.18 to -9.97; I² = 41%) over 12 weeks.

Conclusion

ESPB seems to provide pain relief in Herpes Zoster patients, with a prolonged benefit in the acute stage. Also, ESPB reduced the need for analgesics over 12 weeks. More research is needed to corroborate this practice.

Study Registration Number and Date

This article was prospectively registered in PROSPERO (www.crd.york.ac.uk/prospero, CRD42024566674).